Healthcare Provider Details

I. General information

NPI: 1730293903
Provider Name (Legal Business Name): LEELA S JOSYULA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEELA VEMURI

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 26TH AVE E
BRADENTON FL
34208-7707
US

IV. Provider business mailing address

101 RIVERFRONT BLVD STE 710
BRADENTON FL
34205-8812
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-8600
  • Fax:
Mailing address:
  • Phone: 941-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME89051
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA04158300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: